Inhibitors of sodium glucose cotransporter 2: Canagliflozin added to Insulin therapy improves glycemic control and decreases body weight in patients with type 2 diabetes mellitus


There are limited data about the effects of sodium glucose cotransporter 2 inhibitors when used with insulin. The efficacy and safety of Canagliflozin in patients with type 2 diabetes using Insulin was reported.

The Canagliflozin Cardiovascular Assessment Study is a double-blind, placebo-controlled study that randomized participants to placebo, Canagliflozin 100 mg, or Canagliflozin 300 mg once daily, added to a range of therapies.

The primary end point of this substudy was the change in HbA1c from baseline at 18 weeks among patients using Insulin; 52-week effects were also examined.

Individuals receiving Insulin at baseline were randomized to receive placebo ( n = 690 ), Canagliflozin 100 mg ( n = 692 ), or Canagliflozin 300 mg ( n = 690 ).
These individuals were 66% male and had a median age of 63 years, mean HbA1c of 8.3% [ 67 mmol/mol ], BMI of 33.1 kg/m2, estimated glomerular filtration rate of 75 mL/min/1.73 m2, fasting plasma glucose of 9.2 mmol/L, and a median daily Insulin dose of 60 international units.
Most individuals were using basal/bolus Insulin.

Reductions in HbA1c with Canagliflozin 100 and 300 mg versus placebo were -0.62% ( 95% CI -0.69, -0.54; -6.8 mmol/mol [ 95% CI -7.5, -5.9 ]; P less than 0.001 ) and -0.73% ( 95% CI -0.81, -0.65; -8.0 mmol/mol [ 95% CI -8.9, -7.1 ]; P less than 0.001 ), at 18 weeks; and -0.58% ( 95% CI -0.68, -0.48; -6.3 mmol/mol [ 95% CI -7.4, -5.2 ] ) and -0.73% ( 95% CI -0.83, -0.63; -8.0 mmol/mol [ 95% CI -9.1, -6.9 ] ) at 52 weeks.

There were significant falls in fasting plasma glucose, body weight, and blood pressure at both time points, and a greater incidence of hypoglycemia, genital mycotic infections, and hypovolemia with both canagliflozin doses.

In conclusion, Canagliflozin added to Insulin therapy improves glycemic control and decreases body weight.
There was a greater frequency of several anticipated side effects, although few led to discontinuation of treatment. ( Xagena )

Neal B et al, Diabetes Care 2014; Epub ahead of print

XagenaMedicine_2014



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